eMedicine Specialties > Dermatology > Bacterial Infections
Lymphogranuloma Venereum: Treatment & Medication
Updated: Sep 2, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
Treatment
Medical Care
The treatment of choice for lymphogranuloma venereum (LGV) is doxycycline (100 mg orally bid for 21 d). Although azithromycin is effective against other chlamydial strains and may prove to be effective against infection with LGV serovars, no controlled treatment trials support the use of azithromycin treatment for LGV. Incision and drainage may result in nonhealing fistula formation, which can be minimized by draining involved lymph nodes from above the inguinal ligament. Symptomatic treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and local heat for pain relief may be useful adjuncts.
Immunocompromised persons, such as those with HIV infection, should receive the same treatment as immunocompetent persons; however, given the lack of data, patients with HIV infection and other immunocompromising conditions should be followed closely to assess resolution of symptoms.9
The New York State Department of Health clinical guideline summary, Lymphogranuloma Venereum (LGV), may be of interest.10
Surgical Care
Surgery often is necessary for repair of late lymphogranuloma venereum (LGV) complications such as fistulas and strictures.
Consultations
Surgical consultation for lymphadenopathy is generally not required unless extensive buboes require further exploration. For tertiary disease, appropriate surgical consultation is indicated.
A clinical guideline summary from the US Preventive Services Task Force, Behavioral counseling to prevent sexually transmitted infections: U.S. Preventive Services Task Force recommendation statement, may be helpful.11
Medication
The goal of pharmacotherapy for lymphogranuloma venereum (LGV) is to reduce morbidity and to prevent complications.
Antibiotics
Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.
Doxycycline (Doryx, Bio-Tab)
Inhibits protein synthesis in bacteria by binding to the 30S and possibly the 50S ribosomal subunits.
Adult
100 mg PO bid for 21 d (full course)
Pediatric
<8 years: Not recommended
>8 years: 4.4 mg/kg PO qd or divided bid on day 1 then 2.2-4.4 mg/kg/d PO qd or divided bid; not to exceed 200 mg/d
Antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate can decrease bioavailability; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; monitor prothrombin activity in patients taking both medications concurrently; coadministration of tetracyclines can decrease pharmacologic effectiveness of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Use in last half of pregnancy and in children <8 y may cause permanent dental discoloration; in conjunction with prolonged exposure to sunlight or tanning equipment, can cause photosensitivity reaction; lower dosing in patients with renal impairment and, if therapy is prolonged, consider drug serum level determinations; never administer outdated tetracyclines because degradation products of tetracyclines are highly nephrotoxic and can cause Fanconilike syndrome
Erythromycin base (Erythrocin)
Inhibits RNA-dependent protein synthesis, possibly by stimulating the dissociation of peptidyl t-RNA from ribosomes. This inhibits bacterial growth (ie, erythromycin is bacteriostatic, not bacteriocidal). In children, consider age, weight, and severity of infection to determine proper dosage. When bid dosing is desired, half total daily dose may be taken q12h. For more severe infections, dose may be doubled.
Adult
500 mg PO qid for 21 d
Pediatric
30-50 mg/kg/d PO divided q6-8h
Theophylline, digoxin, carbamazepine, and cyclosporine toxicity may increase when administered concurrently; may potentiate anticoagulant effects of warfarin
May significantly alter metabolism of nonsedating antihistamines and cause serious adverse cardiovascular events; concurrent use of lovastatin and erythromycin may cause rhabdomyolysis in patients who are seriously ill; may increase serum theophylline levels and toxicity; concomitant administration of digoxin may result in elevated serum digoxin levels; coadministration can increase effects of anticoagulants; concurrent use with ergotamine or dihydroergotamine has been associated with acute ergot toxicity; erythromycin may decrease clearance of triazolam and midazolam; erythromycin in patients taking other drugs metabolized by cytochrome P-450 system may be associated with elevations in serum concentrations of those drugs; has demonstrated QTc prolongation in combination with other drugs that prolong the QT interval
Documented hypersensitivity; hepatic impairment
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Caution in liver disease; estolate preparation may cause cholestatic jaundice; GI adverse effects are common; therefore, administer after meals; discontinue if nausea, vomiting, malaise, abdominal colic, and/or fever occur
More on Lymphogranuloma Venereum |
| Overview: Lymphogranuloma Venereum |
| Differential Diagnoses & Workup: Lymphogranuloma Venereum |
Treatment & Medication: Lymphogranuloma Venereum |
| Follow-up: Lymphogranuloma Venereum |
| References |
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References
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Further Reading
Keywords
lymphogranuloma venereum, LGV, Chlamydia trachomatis, C trachomatis, STD, sexually transmitted chlamydial disease, sexually transmitted disease, chlamydia
Treatment & Medication: Lymphogranuloma Venereum